Health Taken Hostage Cruel Denial of Medical Care in Iran’S Prisons
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HEALTH TAKEN HOSTAGE CRUEL DENIAL OF MEDICAL CARE IN IRAN’S PRISONS Amnesty International is a global movement of more than 7 million people who campaign for a world where human rights are enjoyed by all. Our vision is for every person to enjoy all the rights enshrined in the Universal Declaration of Human Rights and other international human rights standards. We are independent of any government, political ideology, economic interest or religion and are funded mainly by our membership and public donations. © Amnesty International 2016 Except where otherwise noted, content in this document is licensed under a Creative Commons Cover photo: © Tavaana / Mana Neyestani (attribution, non-commercial, no derivatives, international 4.0) licence. https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode For more information please visit the permissions page on our website: www.amnesty.org Where material is attributed to a copyright owner other than Amnesty International this material is not subject to the Creative Commons licence. First published in 2016 by Amnesty International Ltd Peter Benenson House, 1 Easton Street London WC1X 0DW, UK Index: MDE 13/4196/2016 Original language: English amnesty.org CONTENTS EXECUTIVE SUMMARY 4 METHODOLOGY 8 1. LEGAL BACKGROUND 10 1.1. International human rights law and standards 10 1.2. Iranian law 11 2. DENIAL OF MEDICAL CARE IN IRAN’S PRISONS 13 2.1. Denial of timely specialized medical care outside prison 15 2.2. Intentional interruption or discontinuation of treatments 20 2.3. Denial of release on medical grounds 21 2.4. Withholding medication 23 2.5. Gender-specific abuses 25 3. ‘CONFESSION’ AS A PRECONDITION FOR MEDICAL CARE 26 4. ABUSED AND BETRAYED BY MEDICAL PROFESSIONALS 29 5. ILL AND ILL-TREATED 32 5.1. Excessive and unnecessary use of restraints 32 5.2. Beatings and harassment 34 5.3. Intrusion on physical privacy 35 5.4. Denial of medical care for torture-related injuries 36 6. HUNGER STRIKES AND REPRISALS 38 7. RECOMMENDATIONS 43 HEALTH TAKEN HOSTAGE CRUEL DENIAL OF MEDICAL CARE IN IRAN’S PRISONS 3 Amnesty International EXECUTIVE SUMMARY In April 2016, prisoner of conscience Omid Kokabee, a 33-year-old physicist sentenced to 10 years’ imprisonment underwent surgery to remove his right kidney, which had become badly damaged by advanced cancer. The news of his ill-health triggered a global wave of sympathy and outrage, particularly as it was revealed that he had complained of kidney problems for nearly five years but the authorities had kept denying him adequate medical care including diagnostic tests. In the days that followed his surgery, a picture from an earlier period of hospitalization in November 2015 that showed the frail young scientist being chained to his hospital bed circulated online, sending further shock waves through social media. The picture encapsulated the cruelty of a criminal justice system in which prison and judicial authorities recklessly ignore the medical needs of prisoners. Iran’s criminal justice system is notorious for imprisoning people merely for peacefully exercising their human rights. However, the legal framework relating to the rights of prisoners guarantees, in theory, that they should at least benefit from adequate medical care. Iran’s prison regulations require the prison administration to provide prisoners with regular medical check-ups, and ensure that their medical needs are addressed. They also provide that prisoners may be granted medical leave or transferred to treatment centres outside prison when the care they need is not available in prison. Iran’s Code of Criminal Procedure further authorizes judges to postpone the implementation of a prison sentence when imprisonment would exacerbate the illness of the prisoner, or to issue an alternative sentence if the individual is deemed too ill to serve. The reality in Iran’s prisons is, however, very different. Amnesty International’s research shows that, in general, the prison regulations are flouted in practice and, in particular, political prisoners, including prisoners of conscience, are denied adequate medical care – a key human right which under international law and standards must not be adversely affected by imprisonment. The 18 individual cases highlighted in this report, which present only a snapshot of the shocking cruelty suffered by political prisoners who have health problems, demonstrate that the denial of adequate medical care is generally not due to lack of resources. Neither have the Iranian authorities made this claim. Rather, there is strong evidence, in all the cases, that the denial is a deliberate act by the judiciary, in particular the Office of the Prosecutor, and/or the prison administration. In some of the cases, there is also evidence that the denial is being used as a means to extract “confessions” from political prisoners or to intimidate or punish them. For example, the authorities have repeatedly put Zeynab Jalalian, an Iranian Kurdish woman serving a life sentence in Khoy Prison, West Azerbaijan province, under pressure to “confess” as a condition to access an urgently needed eye surgery. She is at risk of losing her sight due to a lack of specialized treatment for a worsening eye problem that may have been caused by torture. Common practices that threaten the health and lives of political prisoners include the following: DENIAL OF TIMELY SPECIALIZED MEDICAL CARE OUTSIDE PRISON Amnesty International has documented a pattern of political prisoners being denied timely specialized medical care outside prison. This is well illustrated by the case of Iranian Kurdish political prisoner Afshin Sohrabzadeh who was long denied the specialized medical care that he urgently needed for an HEALTH TAKEN HOSTAGE CRUEL DENIAL OF MEDICAL CARE IN IRAN’S PRISONS 4 Amnesty International intestinal cancer that resulted, among other things, in recurring gastrointestinal bleeding. Up until 25 June, when he was granted temporary medical leave, the authorities kept him in a remote prison in Minab, Hormozgan province, even though the province lacks the medical facilities that he needs, and denied his repeated requests for medical leave. They further hindered his access to government- subsidized health insurance, and seemed to have required that his family pay for his treatment, knowing that they cannot afford to do so. This is in breach of international law, which requires that states pay the medical expenses of all prisoners, completely and without discrimination. WITHHOLDING MEDICATION The authorities have denied some political prisoners medication, apparently as a form of punishment. Political prisoner Iraj Mohammadi and prisoners of conscience Narges Mohammadi, Hossein Ronaghi Maleki, Sayed Hossein Kazemeyni Boroujerdi and Alireza Rasouli are among those whose cases Amnesty International has documented. A related problem has been the failure of authorities to provide regular check-ups in order to ensure that the prisoner is receiving the right dose of medication. In the case of prisoner of conscience Afif Naimi, one of seven imprisoned leaders of Iran’s Baha’i community who suffers from a severe blood clotting disorder, the failure to carefully monitor and adjust the dose of his medication has contributed to recurrent bleeding and loss of consciousness, resulting in his frequent hospitalization. DENIAL OF RELEASE ON MEDICAL GROUNDS The Iranian authorities have a track record of refusing to release prisoners who are critically ill on medical grounds and forcing prisoners who have been granted medical leave to interrupt their treatment and return to prison against medical advice. Highly emblematic here are the cases of prisoners of conscience Hossein Ronaghi Maleki, Saeed Hosseinzadeh and Afif Naimi, who have been imprisoned even though doctors associated with the Legal Medicine Organization of Iran (a state forensic institute) have deemed them to be unfit to remain in prison due to the severity of their health problems, which include, respectively, a kidney disease, rheumatoid arthritis, and a severe blood clotting disorder. HUNGER STRIKES AND REPRISALS Political prisoners suffering from deteriorating health sometimes feel that they have no choice but to go on hunger strike to compel the authorities to provide them with medical care. Sometimes, this compels the authorities to transfer the hunger striker to hospital or grant them short-term medical leave, but they often force the prisoner to interrupt their treatment after a brief period and return to prison against medical advice. In some cases though, even the drastic step of a hunger strike has not moved the authorities to grant access to urgent or specialized medical care. Indeed, some prisoners have faced threats or reprisals for staging such protests. For example, prisoner of conscience Alireza Rasouli, who is serving a three-and-a-half year prison sentence in Mahabad Prison, West Azerbaijan province, was sentenced in September 2015 to three additional years in prison on charges of “spreading propaganda against the system” and “gathering and colluding to commit crimes against nationality security”, including through staging hunger strikes “at the behest of foreign opposition groups.” He suffers from osteonecrosis (a bone disease) of the leg. The disease has progressed considerably because it has been left untreated, leading to severe knee and hip pain, and restricted mobility. He has been on three hunger strikes in protest at the authorities’ refusal to provide him with a surgery he needs to relieve the pain and prevent potentially